title: Severity and prognostic assessment of the endotoxin activity assay in biliary tract infection.
abstract: BACKGROUND
  Acute cholangitis and cholecystitis (AC) often progress to severe septic conditions. We evaluated the endotoxin activity assay (EAA) for assessment and prediction of the severity of AC.
  
  
  METHODS
  We retrospectively reviewed 98 patients diagnosed with AC. We divided them into low (<0.4) and high (≥0.4) groups based on EAA values.
  
  
  RESULTS
  Endotoxin levels showed no correlation with EAA values. Serum C-reactive protein (8.57 vs. 5.23 mg/dl, P = 0.02), procalcitonin (2.45 vs. 0.48 ng/ml, P = 0.004), and the positive culture rate of blood (50% vs. 15%, P < 0.001) were significantly higher in the high group than in the low group. Platelet counts were significantly lower in the high group than in the low group (23.9 vs. 13.5 10(4) /ml, P = 0.004). The ratio of patients with a Japanese Association for Acute Medicine disseminated intravascular coagulation score ≥4 (32% vs. 14%, P = 0.032) was significantly higher in the high group than in the low group. There was a significantly higher percentage of patients with a severe grade of AC in the high group than patients with a mild or moderate grade (32% vs. 15%, P = 0.05).
  
  
  CONCLUSIONS
  Endotoxin activity assay is useful for assessment and early prediction of septic conditions due to AC.
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawaku, Yokohama, 239-0004, Japan. endoit@med.yokohama-cu.ac.jp.
authors.forename: Mari
authors.initials: M
authors.lastname: Sato
authors.forename: Ryusei
authors.initials: R
authors.lastname: Matsuyama
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Kadokura
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Mori
authors.forename: Takafumi
authors.initials: T
authors.lastname: Kumamoto
authors.forename: Kazunori
authors.initials: K
authors.lastname: Nojiri
authors.forename: Koichi
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takeda
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kubota
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D001769:Blood / Q000382:microbiology; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D002764:Cholecystitis / Q000097:blood / Q000175:diagnosis*; D004731:Endotoxins / Q000097:blood*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011498:Protein Precursors / Q000097:blood; D012189:Retrospective Studies
chemical_list: C000606589:CALCA protein, human; D004731:Endotoxins; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
keywords: Cholangitis; Endotoxin; Endotoxin activity assay; Sepsis